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Re: episiotomy and shoulder dystocia From: Harvey S. Marchbein, M.D. (hmarchbein@worldnet.att.net) Wed Apr 30 22:58:37 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Robert J. Woolley: "Re: episiotomy and its effects on perineal body/external an" Previous message: John Robertson: "Re: seasonal amenorrhea" In reply to: Margie Dacko: "Re: episiotomy and shoulder dystocia" At Wed, 30 Apr 1997, Margie Dacko wrote: > >Sorry Ron, but I have had "true" shoulder dystocias and I have also >never had a third or fourth degree episiotomy or laceration from the >dystocia or from the maneuvers involved in resolving the dystocia, >and usually it has been with an intact perineum. It can happen! Margo, I tried to email you personally about your success rate with intact perineii(?) and shoulder dystocias but it got returned. so I'm posting to the list instead. What I don't quite get the grasp of is your "on hands and knees" positon for the paatient with shoulder dystocia. As much as I try, and I have tried (and even discussed it with my partners), I can't envision that position giving more room for a shoulder dystocia since every response to the list has stated that it is a bony dystocia, not a soft tissue problem. I'm having trouble understanding the mechanics behind a change in the mother's positon and a change in the orientation/size of the bony pelvis which is restricting the delivery of the infant's shoulders. In case this is misconstrued....this is an honest question and not sarcastic. Anything I can learn to help a patient is worthwhile. Also, any references on this technique? Thanks for any light you can shed on my biomechanical dilemma. -- Harvey Harvel the Marvel Harvey S. Marchbein, M.D. FACOG, FACS President, Nassau Obstetrical and Gynecological Society, Inc. OBGYN.net U.S. Representative, New York http://www.obgyn.net/states/bios/marchbein.htm Private practice, Long Island, N.Y. ********************************* It's better to be lucky than to be smart. Even smart people can have an off day! ********************************* Next message: Robert J. Woolley: "Re: episiotomy and its effects on perineal body/external an" Previous message: John Robertson: "Re: seasonal amenorrhea" In reply to: Margie Dacko: "Re: episiotomy and shoulder dystocia"

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